The following are my write-up and comments on two lectures which were given on Oct 12th 2019 at West Sussex History of Medicine Society, St Richards Hospital, Chichester. Afifah Hamilton https://rosemarycottageclinic.co.uk/blog/author/afifahhamilton/

The Contagious Diseases Acts: Protection, Prejudice and Punishment

Comments on a lecture given on by
Mr Graham Kyle MB ChB MSc LLM FRCSEd FRCOphth DHMSA

Apart from the fact that I was entirely ignorant about the subject matter, I found Mr Kyle’s presentation to be a marvellous demonstration of the ‘law of unintended consequences’; or that ‘the road to hell is paved with good intentions’. Tell me if you agree in the comments section below.

In 1864 around 30% of the army (i.e. 42,000 men) were out of action due to sexually transmitted infections. The legislature responded with an extraordinary piece of legislation: the Contagious Diseases Acts.

This act of parliament required that in certain garrison and naval towns local prostitutes should be invited to register with the police where they should then volunteer themselves to be regularly checked for signs of sexually transmitted diseases. The examination involved the use of a metal vaginal speculum.

If they did not register they would be arrested and then asked to undergo the ‘voluntary’ vaginal examination. Should they still refuse they would be imprisoned for 1-2 months with hard labour! On the other hand, if the voluntary examinations revealed venereal disease the women were given a full 6 months sentence in a ‘lock up hospital’, i.e. imprisoned.

In 1866 and 1869 further Acts were used which extended the police powers to a greater radius around the garrisons, thereby including more towns and villages, such that increasing numbers of women people fell under the scope of the new police powers. Eventually, after significant objection by civil groups, and especially the Ladies National Association, lead by Josephine Butler, the Acts were eventually repealed in 1886.

The objections were all well founded, and really, those passing the bills that lead to the Acts of Parliament should have been able to foresee the problems they were about to create; as more and more women fell under these draconian procedures the public became increasingly alarmed. Whereas In 1864 when the first Act came into force, only 30 women were examined, just 9 years later that had risen to a phenomenal 42,211 women.

Not only were these numbers alarming, but it wasn’t always clear who was being included in these heavy-handed police tactics. Perfectly innocent women, it transpired, were being required to register as prostitutes — you imagine how offensive that was! — yet if they refused to do so, they were arrested and forcibly examined. No doubt thousands of innocent women surrendered voluntarily rather than endure the forced ‘steel rape’ as it was referred to by a horrified press.

Another factor which added to the controversy was the perception that the Acts were creating a series of state-run brothels. For the British, this was far too close to the continental approach to prostitution and was viewed as morally repugnant. With mounting opposition the law was finally overturned.

In the Q & A session following the lecture, I asked about the probability that the specula used on these unfortunate women might well have spread the very infection these laws were designed to stamp out. Mr Kyle agreed that it was probable, and went on to explain that William Acton, one of the gynaecologist performing these examinations, was able to examine up to 158 women in 45 minutes! I seems unlikely that any form of sterilisation of instruments took place between these between ‘steel rapes’. He added that a quick examination with such means could not possibly prove the presence or absence of either gonorrhoea or syphilis, as these would require proper samples to be obtained and laboratory analysis to take place, neither of which were quite available at that time.

It is staggering to reflect on how this ostensibly well-intentioned act could have been got so wrong – to permit such a large number of women to be sexually assaulted at the hands of the state. And one can only imagine to what extent venereal disease was spread in the process.

Finally, it is interesting to consider why it was women and not the men who paid for prostitutes that these Acts of Parliament targeted. The answer was, apparently, that the soldiers and sailors didn’t much like being examined, and the doctors didn’t want to examine male genitalia! This is so ridiculous, as, in the male, the signs and symptoms of VD are far more reliable than in the female, so… how crazy is that!? Thank Goodness that the good people of England pushed back against these laws such that they only had their power for 22 years.

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The History of Spermatorrhoea — the little known ‘Male Hysteria’

The second lecture of the day was by the WSHOMS’s ‘Leader Elect’, the Consultant Urologist Dominic Hodgson MBChB, DHMSA, MA, MSc, FRCS(Urol).

He presented a talk titled ‘Masturbation or Mass Delusion – the Story of Spermatorrhoea’

Unfortunately, the history of the medical treatment of the ‘Male Hysteria’ reveals an almost religious zeal of the proponents who inflict their disturbing ideas on the public at large. To me it is a lesson in why doctors and do-gooders are generally best avoided. I guess it could, like the previous lecture, be considered another case of the road to hell being paved with good intentions.

Spermatorrhea or “seminal weakness” is described as a condition of excessive, involuntary ejaculation. It is recognised in traditional Chinese and Indian medicine, as well as in 18th and 19th century Western medicine, where it was believed to have “corrupting and devastating effects on the mind and body”, particularly if it took place outside of marriage. [Reference]

A renowned authority on spermatorrhoea in the 19th century was one Claude Francois Lallemand (1790 – 1854). He advocated, among other ideas, that the foreskin was the chief cause of the condition, with circumcision as one of the less bizarre attempts at a ‘cure’.

Other treatments were more esoteric and barbaric. Since a picture paints a thousand words, all you need for me to convey the whole subject of this lecture is this one picture:

Other hellish ‘treatments’ for spermatorrhoeaincluded poking things up the urethra to cauterise the tissue, which probably worked, in as much as it almost certainly reduced the tendency to masturbation, at least temporarily, due to intense pain!

We like to think that the practice of medicine has always been in the hands of the best minds amongst us, but, I have to say, some of the diagnoses presented in this lecture did not support such a theory.

For example, a 22 year old man was told by his physician that his heart and stomach weakness were caused by his habit of masturbating… Well, I don’t think so, do you?

In another eyebrow-raising report one Dr W Wood thought that if left ‘untreated’ masturbation would result in men ending up in the insane asylum…. Really? On what evidence? Surely it was moral prejudice, not science, that drove such hypotheses?

Reflecting on the widespread acceptance of such bizarre and unhelpful beliefs among doctors of the past, it becomes clear that it is probably only with the benefit of hindsight that we can appreciate the folly of the past. Which leads to the uncomfortable question of the degree to which medical practices today are based on conviction rather than evidence. What mistakes are doctors of the present making?

Well, here are two perfectly logical procedures that were used extensively until very recently when tit was realised that they did more harm than good. 1) Stents, it has been discovered, do not reduce cardiac events or extend life — much to the chagrin of current cardiology dogma and practice (see this article) and, 2) Cooling the head following brain injuries, does more harm than good (see this article). Until very recently, cooling head injuries was believed to reduce brain swelling — totally logical, widely practised, but, as it turns out, completely wrong.

Of course we all know what to blame for our tendency to shortsightedness in regards many medical matters, as eyesight is famously made worse by onanism…!

Many thanks to both our speakers.

Afifah Hamilton https://rosemarycottageclinic.co.uk/blog/author/afifahhamilton/